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Gialdini C, Ramón Michel A, Romero M, Ramos S, Carroli G, Carroli B, Gomez Ponce de León R, Vila Ortiz M, Lavelanet A. Multicountry research on comprehensive abortion policy implementation in Latin America: a mixed-methods study protocol. BMJ Open 2024; 14:e073617. [PMID: 38245008 PMCID: PMC10806677 DOI: 10.1136/bmjopen-2023-073617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Access to comprehensive abortion care could prevent the death of between 13 865 and 38 940 women and the associated morbidity of 5 million women worldwide. There have been some important improvements in Latin America in terms of laws and policies on abortion. However, the predominant environment is still restrictive, and many women, adolescents and girls still face multiple barriers to exercise their reproductive rights. This research will systematically assess comprehensive abortion policies in five Latin American countries (Argentina, Colombia, Honduras, Mexico and Uruguay). The aim is to identify barriers, facilitators and strategies to the implementation of abortion policies, looking at four key dimensions-regulatory framework, abortion policy dynamics, abortion service delivery and health system and health outcomes indicators-to draw cross-cutting lessons learnt to improve current implementation and inform future safe abortion policy development. METHODS AND ANALYSIS A mixed-method design will be used in the five countries to address the four dimensions through the Availability, Accessibility, Acceptability and Quality of Care model. The data collection tools include desk reviews and semi-structured interviews with key actors. Analysis will be performed using thematic analysis and stakeholder analysis. A regional synthesis exercise will be conducted to draw lessons on barriers, facilitators and the strategies. ETHICS AND DISSEMINATION The project has been approved by the WHO Research Ethics Review Committee (ID: A66023) and by the local research ethics committees. Informed consent will be obtained from participants. Data will be treated with careful attention to protecting privacy and confidentiality. Findings from the study will be disseminated through a multipurpose strategy to target diverse audiences to foster the use of the study findings to inform the public debate agenda and policy implementation at national level. The strategy will include academic, advocacy and policy arenas and actors, including peer-reviewed publication and national and regional dissemination workshops.
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Affiliation(s)
- Celina Gialdini
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
- Blanquerna Ramon Llull University Faculty of Health Sciences, Barcelona, Spain
| | | | - Mariana Romero
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas, (CONICET), Buenos Aires, Argentina
| | - Silvina Ramos
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | | | - Berenise Carroli
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Rodolfo Gomez Ponce de León
- Latin American Center of Perinatology Women and Reproductive Health (CLAP/WR), Pan American Health Organization, Montevideo, Uruguay
| | - Mercedes Vila Ortiz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antonella Lavelanet
- Department of Sexual and Reproductive Health and Research and UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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McGovern T, Favier M, Gil L, Kitaba-Gaviglio B, Bencomo C, Memaj I, Garbers S, Maier M. Applying global lessons to protect abortion access in the United States. BMJ 2024; 384:e073833. [PMID: 38171571 DOI: 10.1136/bmj-2022-073833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Terry McGovern
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | | | - Laura Gil
- Grupo Médico por el Derecho a Decidir, Colombia
| | | | - Clarisa Bencomo
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Ira Memaj
- CUNY Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Samantha Garbers
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Malia Maier
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- Program on Global Health Justice and Governance, Columbia University Mailman School of Public Health, New York, NY, USA
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Ferguson L, Jardell W, Lambert-Peck M, Guo L, Lopez S, Canaves V, Filmer-Wilson E. Mind the Gap: Understanding Differences Between Sexual and Reproductive Health-Related Legal Frameworks on Paper and in Practice. Front Glob Womens Health 2022; 3:838976. [PMID: 35602852 PMCID: PMC9120771 DOI: 10.3389/fgwh.2022.838976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction UNFPA recently developed a composite indicator to assess sexual and reproductive health (SRH)-related laws as part of the Sustainable Development Goals monitoring framework (Indicator 5.6.2). However, there is still little understanding of how best to ensure a supportive SRH-related legal framework can improve SRH outcomes. This research draws on country case studies (Colombia, Malawi, Uruguay, Zambia) to provide more generalizable lessons on the processes by which these laws are translated into practice and their impact on lived realities. Methods Peer-reviewed and gray literature on laws and policies related to maternity care, contraception, sexuality education, HIV and HPV was reviewed. Key informant interviews were carried out with 8–16 people in each country, including representatives of government, civil society and academia to understand factors affecting implementation of relevant laws and policies. Findings were thematically analyzed by country and contextualized within each country's score on Indicator 5.6.2 and relevant SRH outcome data. Findings Across these countries, some common organizational steps help move from laws on paper to impacting people's lives including budget allocation, development of technical guidance, health worker training, population awareness creation and demand generation. It is also important to address sociocultural challenges such as entrenched inequalities, conservative cultural and religious beliefs and the potential existence of customary law. Challenges can be encountered across all these steps and can vary based on the area of SRH: implementation of laws to reduce maternal mortality is generally less controversial than laws around abortion, often making the latter harder to implement. Local specificities in structures, systems and cultures bring opportunities and challenges, highlighting the need for tailored actions. Discussion A legal framework supportive to SRH is critical, particularly in the face of backlash against sexual and reproductive rights, but alone it is insufficient. Understanding that a generic pathway exists for moving laws into practice is a critical starting point for exploring the specificities of each national context as a way of identifying entry points for action. These findings can be used to inform advocacy and monitoring to help ensure that the potential benefits of supportive SRH-related laws can be realized in these four countries and around the world.
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Affiliation(s)
- Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Laura Ferguson
| | - William Jardell
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | - Miles Lambert-Peck
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | - Lillie Guo
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
| | - Sophia Lopez
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, United States
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Schaaf M, Khosla R. Necessary but not sufficient: a scoping review of legal accountability for sexual and reproductive health in low-income and middle-income countries. BMJ Glob Health 2021; 6:bmjgh-2021-006033. [PMID: 34321233 PMCID: PMC8319982 DOI: 10.1136/bmjgh-2021-006033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/02/2021] [Indexed: 01/21/2023] Open
Abstract
Background This paper is a scoping review of the impact of legal accountability efforts for sexual and reproductive health and rights (SRHR), exploring the links between legal accountability strategies and changes in the desired SRHR outcomes. Methods We defined legal accountability as use of the judicial system following state failure to respect, protect or fulfil SRHR as enshrined in national law, as well as individuals’ or the state’s use of criminal law mechanisms to prevent unwanted behaviour and to provide remedy. We undertook a keyword search in PubMed, Scopus and LexisNexis and then consulted a group of experts to provide guidance regarding further peer-reviewed and grey literature, yielding a total of 191 articles. Results The majority of the empirical, peer-reviewed articles identified were regarding abortion law and abortion care availability, followed by violence against women. Most of these articles explore the gaps between law and practice. We identified seven key factors that shape the efficacy of legal accountability efforts, including the ways a law or court decision is formulated, access to courts, the (dis)advantages of criminal law in the given context, cultural norms, politics, state capacity and resources and the potential for further litigation. Many articles explained that use of the judiciary may be necessary to effect change and that the act of claiming rights can empower, but that legal avenues for change can be imperfect tools for justice. Conclusions Legal accountability can be effective as part of a broader, long-term strategy, with due attention to context.
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Affiliation(s)
- Marta Schaaf
- Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rajat Khosla
- Research, Advocacy, and Policy, Amnesty International, London, UK
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Restrepo-Bernal DP, Colonia-Toro A, Duque-Giraldo MI, Hoyos-Zuluaga C, Cruz-Osorio V. [SAFETY OF THE TREATMENT FOR VOLUNTARY PREGNANCY TERMINATION BY GESTATIONAL AGE. MEDELLÍN, COLOMBIA, 2013-2014]. ACTA ACUST UNITED AC 2020; 70:174-180. [PMID: 31738487 DOI: 10.18597/rcog.3267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 09/15/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the safety of medical and surgical treatments used in women seeking voluntary pregnancy termination. METHODS Historical cohort of all pregnant women with up to 26 weeks of gestation who received treatment for voluntary pregnancy termination in a referral institution in Medellín, Colombia, between January 2013 and December 2014.Sampling was consecutive. Measured variables included sociodemographic and obstetric variables, undesired effects, and complications of the voluntary pregnancy termination treatment. A descriptive analysis was carried out. RESULTS Overall, 87 women were included. The mean age at the time of termination was 24 years (inter-quartile range [IQR] = 12), 69.0% were single, and 73,4% were unemployed. The main reason for termination was the risk to the mother's health in 61,0% of cases, followed by a history of sexual violence in 26.4% and fetal malformations in 12.6%; a total of 70 women (80,4%) had less than 18 weeks of gestation and were treated with misoprostol plus manual vacuum aspiration; 17 (19,6%) had between 18 and 26 weeks of gestation and were treated with misoprostol followed by dilation and curettage. The first group (gestational age <18 weeks) experienced undesired effects such as pain and vomiting; in the second group (> or equal to 18 weeks), 41.0% of the women experienced hemorrhage. CONCLUSIONS The risk to the mother's health was the main reason for the termination of pregnancy. Termination before 18 weeks was found to be safe, while termination between 18 and 26 weeks using misoprostol and curettage was associated with a high frequency of hemorrhage.
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Keefe-Oates B, Makleff S, Sa E, Forero LJ, Mendoza D, Olaya MA, Avila Morales F, Friedman J, Baum SE. Experiences with abortion counselling in Mexico City and Colombia: addressing women's fears and concerns. CULTURE, HEALTH & SEXUALITY 2020; 22:413-428. [PMID: 31020914 DOI: 10.1080/13691058.2019.1604995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 04/03/2019] [Indexed: 06/09/2023]
Abstract
Despite liberalised abortion laws in Colombia and Mexico City, ongoing abortion-related stigma and lack of knowledge of abortion laws can impede access to care. Organisations offering abortion services may support women seeking services by providing counselling and information. We conducted 30 in-depth interviews with women in Colombia and Mexico City after their abortion to understand their feelings of stigma, fears and concerns before accessing services, and how abortion counselling addressed those concerns. Women in both regions cited concerns about abortion safety, fears of judgement from community members and some reported self-judgement or guilt. Before arriving to care, women in Colombia were unsure if they qualified for legal abortion under the current law, and many reported fearing legal or social repercussions for seeking an abortion, whereas women in Mexico knew they could access a legal abortion in Mexico City. Women in all clinics reported satisfaction with the counselling services and felt most of their concerns were addressed. However, most women said they continued to fear judgement from members of the community after their procedure. Service-delivery organisations can provide supportive services and decrease women's fears and concerns, although interventions in communities are also needed to reduce stigma and improve information.
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Affiliation(s)
| | - Shelly Makleff
- International Planned Parenthood Federation/Western Hemisphere Region, New York City, NY, USA
| | - Eleuthera Sa
- International Planned Parenthood Federation/Western Hemisphere Region, New York City, NY, USA
| | | | - Doroteo Mendoza
- Fundación Mexicana para la Planeación Familiar (Mexfam), Mexico City, México
| | - Marco Antonio Olaya
- Fundación Mexicana para la Planeación Familiar (Mexfam), Mexico City, México
| | | | - Jennifer Friedman
- International Planned Parenthood Federation/Western Hemisphere Region, New York City, NY, USA
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Fernández Vázquez SS, Brown J. From stigma to pride: health professionals and abortion policies in the Metropolitan Area of Buenos Aires. Sex Reprod Health Matters 2019; 27:1691898. [PMID: 31771465 PMCID: PMC7888029 DOI: 10.1080/26410397.2019.1691898] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Abortion stigma is experienced not only by women but also by providers and health professionals in a wide range of legal contexts. This paper analyses interviews with providers who work in the public health system in the Metropolitan Area of Buenos Aires, Argentina. A court ruling in 2012, FAL/12, changed the interpretation of abortion’s legal status, clarifying the decriminalisation of abortion in cases of rape, and also requiring public policies and procedures to speed up access to legal abortion. Between 2014 and 2017, we conducted 27 in-depth, semi-structured interviews with abortion providers in public facilities across healthcare services in the Metropolitan Area of Buenos Aires. We found the way that health providers dealt with abortion stigma evolved over the course of time, as the abortion debate moved from the margins to the heart of political debate and public policies in Argentina between 2007 and 2017. Providers’ experiences changed as the social and legal context changed. FAL/12 – as a clear, legal ruling – was a landmark and turning point in the way health professionals in public health facilities conduct their activities, making it possible for them to move from providing silent and hidden abortion care, to acknowledging it with pride.
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Affiliation(s)
- Sandra Salomé Fernández Vázquez
- Scholarship Researcher, National Technical and Scientific Research Council (CONICET), Buenos Aires, Argentina. Correspondence:
| | - Josefina Brown
- Senior Researcher, National Technichal and Scientific Council (CONICET), Buenos Aires, Argentina
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Lopes SDN, Oliveira MHBD. Meu corpo, minhas regras: mulheres na luta pelo acesso ao serviço público de saúde para a realização do aborto seguro. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Os direitos humanos são vinculados à luta pela dignidade humana, contexto em que os feminismos, movimentos sociais de luta pela superação das diferenças de gênero, raça e classe, devem se vincular às batalhas dos demais grupos oprimidos. O Código Penal criminaliza o aborto, excetuando quando a gravidez é oriunda de estupro, quando há risco de morte para a gestante ou em caso de gravidez de feto anencéfalo. Apesar da proibição, o aborto não deixa de ser realizado em todos os grupos sociais e raciais, níveis de escolaridade e religiões, consistindo em um dos maiores problemas de saúde pública do País. A luta pelo direito de acesso ao aborto seguro se faz cotidianamente inclusive quando se trata do aborto legal – que já é um direito reconhecido e positivado pelo Estado. Uma vez que, para além da insuficiência dos serviços de saúde que realizam o procedimento, não há adequada capacitação técnica, a objeção de consciência ocorre com frequência, e estigmas e preconceitos rodeiam a questão, contaminando até a norma legal produzida por um Estado laico.
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Stifani BM, Gil Urbano L, Gonzalez Velez AC, Villarreal Velásquez C. Abortion as a human right: The struggle to implement the abortion law in Colombia. Int J Gynaecol Obstet 2018; 143 Suppl 4:12-18. [PMID: 30374985 DOI: 10.1002/ijgo.12672] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In 2006, a Colombian Constitutional Court decision legalized abortion in cases of risk to a woman's physical or mental health, fetal malformation incompatible with life, or rape or incest. This decision resulted from legal action brought by feminist groups, and frames abortion as a human right. Advocates played a key role in implementing the new law by educating providers and the public about its broad interpretations. Healthcare providers and facilities did not have an organized response to the new law. Nonprofit organizations filled this gap, and provide a majority of legal abortions throughout the country. Civil society facilitated implementation of the new law by providing legal accompaniment to women facing barriers to accessing abortions. Despite these efforts, few legal abortions are performed each year, and clandestine, often unsafe abortions continue to prevail. Lack of information about the new law, stigma, and fluctuating political will remain key barriers.
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Affiliation(s)
- Bianca M Stifani
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, New York, NY, USA
| | | | - Ana Cristina Gonzalez Velez
- Grupo Médico por el Derecho a Decidir en Colombia, Bogotá, Colombia.,La Mesa por la Vida y la Salud de las Mujeres, Bogotá, Colombia.,Global Doctors for Choice, New York, NY, USA
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Chavkin W, Stifani BM, Bridgman‐Packer D, Greenberg JM, Favier M. Implementing and expanding safe abortion care: An international comparative case study of six countries. Int J Gynaecol Obstet 2018; 143 Suppl 4:3-11. [DOI: 10.1002/ijgo.12671] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Wendy Chavkin
- Mailman School of Public Health and Department of Obstetrics‐GynecologyColumbia University Medical Center New York NY USA
- Global Doctors for Choice New York NY USA
| | - Bianca M. Stifani
- Department of Obstetrics, Gynecology and Women's HealthAlbert Einstein College of Medicine/Montefiore Medical Center New York NY USA
| | | | - Jamie M.S. Greenberg
- Mailman School of Public HealthColumbia University Medical Center New York NY USA
| | - Mary Favier
- Parklands Surgery Parklands Cork Ireland
- Doctors for Choice Ireland Dublin Ireland
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Maldonado OJ. The decriminalisation of abortion in Colombia as cautionary tale. Social movements, numbers and socio-technical struggles in the promotion of health as a right. Glob Public Health 2018; 14:1031-1043. [DOI: 10.1080/17441692.2018.1504101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Oscar Javier Maldonado
- Research group: Applied Ethics, Work and Social Responsibility, School of Human Sciences, Universidad del Rosario, Bogotá, Colombia
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Küng SA, Darney BG, Saavedra-Avendaño B, Lohr PA, Gil L. Access to abortion under the heath exception: a comparative analysis in three countries. Reprod Health 2018; 15:107. [PMID: 29895292 PMCID: PMC5998589 DOI: 10.1186/s12978-018-0548-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 05/29/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite Britain, Colombia, and some Mexican states sharing a health exception within their abortion laws, access to abortion under the health exception varies widely. This study examines factors that result in heterogeneous application of similar health exception laws and consequences for access to legal abortion. Our research adds to previous literature by comparing implementation of similar abortion laws across countries to identify strategies for full implementation of the health exception. METHODS We conducted a cross-country comparative descriptive study synthesizing data from document and literature review, official abortion statistics, and interviews with key informants. We gathered information on the use and interpretation of the health exception in the three countries from peer-reviewed literature, court documents, and grey literature. We next extracted public and private abortion statistics to understand the application of the law in each setting. We used a matrix to synthesize information and identify key factors in the use of the law. We conducted in-depth interviews with doctors and experts familiar with the health exception laws in each country and analyzed the qualitative data based on the previously identified factors. RESULTS The health exception is used broadly in Britain, somewhat in Colombia, and very rarely in Mexican states. We identified five factors as particularly salient to application of the health exception in each setting: 1) comprehensiveness of the law including explicit mention of mental health, 2) a strong public health sector that funds abortion, 3) knowledge of and attitudes toward the health exception law, including guidelines for physicians in providing abortion, 4) dissemination of information about the health exception law, and 5) a history of court cases that protect women and clarify the health exception law. CONCLUSIONS The health exception is a valuable tool for expanding access to legal abortion. Differences in the use of the health exception as an indication for legal abortion result in wide access for women in Britain to nearly no access in Mexican states. Our findings highlight the difference between theoretical and real access to legal abortion. The interpretation and application of the health exception law are pivotal to expanding real access to abortion.
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Affiliation(s)
- Stephanie A Küng
- Mailman School of Public Health, Heilbrunn Department of Population and Family Health, Columbia University, New York, NY, USA
| | - Blair G Darney
- Oregon Health & Science University Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
- Instituto Nacional de Salud Pública, Centro de Investigacion en Sistemas de Salud, Cuernavaca, Mexico.
| | - Biani Saavedra-Avendaño
- Instituto Nacional de Salud Pública, Centro de Investigacion en Sistemas de Salud, Cuernavaca, Mexico
| | | | - Laura Gil
- Fundación Oriéntame/ESAR, Bogotá, Colombia
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Coast E, Norris AH, Moore AM, Freeman E. Trajectories of women's abortion-related care: A conceptual framework. Soc Sci Med 2018; 200:199-210. [PMID: 29421467 DOI: 10.1016/j.socscimed.2018.01.035] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 11/16/2022]
Abstract
We present a new conceptual framework for studying trajectories to obtaining abortion-related care. It assembles for the first time all of the known factors influencing a trajectory and encourages readers to consider the ways these macro- and micro-level factors operate in multiple and sometimes conflicting ways. Based on presentation to and feedback from abortion experts (researchers, providers, funders, policymakers and advisors, advocates) (n = 325) between 03/06/2014 and 22/08/2015, and a systematic mapping of peer-reviewed literature (n = 424) published between 01/01/2011 and 30/10/2017, our framework synthesises the factors shaping abortion trajectories, grouped into three domains: abortion-specific experiences, individual contexts, and (inter)national and sub-national contexts. Our framework includes time-dependent processes involved in an individual trajectory, starting with timing of pregnancy awareness. This framework can be used to guide testable hypotheses about enabling and inhibiting influences on care-seeking behaviour and consideration about how abortion trajectories might be influenced by policy or practice. Research based on understanding of trajectories has the potential to improve women's experiences and outcomes of abortion-related care.
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Affiliation(s)
- Ernestina Coast
- Dept. of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | | | | | - Emily Freeman
- PSSRU, London School of Economics and Political Science, UK
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Considering strategic litigation as an advocacy tool: a case study of the defence of reproductive rights in Colombia. REPRODUCTIVE HEALTH MATTERS 2015; 22:31-41. [PMID: 25555761 DOI: 10.1016/s0968-8080(14)44804-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Women's Link Worldwide developed a test to determine when an environment is conducive to social change through strategic litigation. We first present our understanding of strategic litigation, and then discuss four conditions for successful and sustainable change using strategic litigation: (1) an existing rights framework; (2) an independent and knowledgeable judiciary; (3) civil society organizations with the capacity to frame social problems as rights violations and to litigate; and (4) a network able to support and leverage the opportunities presented by litigation. Next, we present examples from our work in Colombia that show how analysis of these conditions informed our litigation strategy when confronting a powerful public official who opposes reproductive rights. Two litigation strategies were adopted. The first case was not successful in the courts, but allowed us to introduce our message and build support amongst civil society. The second case built on this momentum and resulted in a victory. Strategic litigation is a powerful tool to advance rights as well as hold governments accountable and ensure compliance with human rights obligations. The strategies developed can be adapted for use in other contexts. We hope they inspire others to protect and promote reproductive rights through strategic litigation when women cannot fully enjoy their rights.
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